Susan's Place Transgender Resources

Hello all,

I've had the same endocrinologist for 4 years and he has never once examined me. I've been on HRT for 2 years almost 2 years and he has never once examined me to see how much breast development I've had. Is this normal?

Erika

Mine hasn't either. She didn't even believe in doing mammograms till after 40.

Mine has a couple of times in about 3 years or so.

Mine never has.  She did make me get an annual physical from my primary care physician though to check A1C and cholesterol.  She also occasionally asks if I am still stopped smoking and always asks if I'm still exercising.


It is better to be hated for what you are than to be loved for what you are not.
André Gide, Autumn Leaves

The PA managing my HRT hasn't either, other than vital signs and weight.  I'm 18 months into HRT.  She is very attentive to results of blood screens and questions me on how I feel and how I'm finding the physical changes.  My GP recently gave me a physical exam, including a breast exam.

My HRT doctor is an internal medicine doctor and not a endocrinologist and she does examine me physically once a year (at least until recently when I finally got insurance and have a PCP who is also internal medicine doctor, but I'm her first transgender patient, but she is open and willing to learn and I've educated her on a few things, and she's done a lot of research herself.) Endocrinologist tend to be more concerned about blood tests than anything else and I prefer an internal medicine doctor over a endocrinologist for HRT. The reason being is the internal medicine doctors have to study what a endocrinologist do and a whole lot more.

Both doctors wanted me to get a mammogram (which I did in October) and both always checks my vitals with every visit. I just saw my HRT doctor today and she says I only need to see her for my surgery letter/pre-check or one year from today, whichever comes first. She gave me enough scripts to last the whole year since my blood work and HRT regimen has been rock steady for the last 2 years with the exception of progesterone added 3 months ago.

So now I have two doctors, one as a PCP and the other for HRT. After surgery I'll just need my PCP at that point as then my HRT would be no different than a cis woman who has had a hysterectomy.

My Endo hasn't either and I have been seeing him for two years now. Hugs
Mariah

Quote from: ErikaTheStrange on December 22, 2016, 01:26:26 PM
Hello all,

I've had the same endocrinologist for 4 years and he has never once examined me. I've been on HRT for 2 years almost 2 years and he has never once examined me to see how much breast development I've had. Is this normal?

Erika

I've never had any kind of physical examination related to HRT, but I get my prescription from my primary care doctor so I do get an annual physical from her.

Quote from: Angélique LaCava on December 22, 2016, 01:38:03 PMShe didn't even believe in doing mammograms till after 40.

Mammograms expose the breast to radiation and may increase the risk of cancer.

Sex, Lies, and Menopause: The Shocking Truth About Synthetic Hormones and the Benefits of Natural Alternatives
T. S. Wiley, Julie Taguchi, M.D., and Bent Formby, Ph.D.

"The other problem with mammography is obvious: Science only knows of
one absolute carcinogen to human tissue on this planet, and that carcinogen
in ionizing radiation.141 If the exposed cells don't die, the DNA breaks and
they mutate. Cancer, as we've explained and footnoted, rarely starts with a
mutated gene; but a gene certainly can be mutated by an outside-the-body
influence like the ionizing radiation of power lines or mammography"

"Mammography is ionizing radiation."

Considering the risk of breast cancer does not appear to increase in TRANSSEXUAL women,

Journal of Clinical & Translational Endocrinology 2 (2015) 55-60

"There is no increase in cancer prevalence or mortality due to transgender HT."

"While some guidelines for transgender medical care express concerns for elevated cancer risk with certain hormone regimes, current data suggest that the risk of cancer may not rise."

"Although studies are small, overall cancer incidence in transgender men and transgender women to-date has not been found to be different than their respective male and female controls [5]. There are no reports of change in breast cancer specific risk among transgender individuals on estrogen compared to secular trends of male breast cancer incidence. Rates are lower relative to secular trends of female breast cancer rates."

it would seem ill advised, I think, and risky to have transsexual women take mammograms as the risks would seem to outweigh the benefits in this specific population. Are men asked and advised to take mammograms? Do they regularly take mammograms? If the answer is no, why should it be any different for transsexual women whose risk, according to the above, is the same.

You could perhaps bring this up with your doctor who may be unaware of some of these things and/or maybe forgot to consider how different your circumstances are from that of a ciswoman. For instance, also,

* Ciswomen are asked to have a mammogram around the age of 40-50 yrs old, that is, 30-40 years after first being exposed to gradually increasing concentrations of estrogen. Say you've been on estrogen for 10 or even 20 yrs, are 20-30 yr old women asked to get mammograms? No.

* Ciswomen have hundreds of menstrual cycles throughout their lives with hormones fluctuating from moderate-high to very low. This is unusual in transwomen where a more constant dose is taken throughout their lives. The number of cycles have been positively associated with the risk of breast cancer, with nuns relative to parous women (less cycles due to pregnancy and breastfeeding) having a much higher incidence of breast cancer.

* Ciswomen's risk of breast cancer increases after the age of 40-50 yrs old when estrogen levels drop. Estrogen has been found in randomized controlled trials to DECREASE breast cancer incidence significantly. These suggest a protective effect of E, or at the very least, that E doesn't cause breast cancer (cause and effect has NEVER been established in ciswomen). Transsexual women, for the most part, take E for the remainder of their lifetime.

Examining yourself (ask a doctor if you dont know how or have yourself be checked) regularly for lumps or changes in breast tissue, in my opinion, should suffice.

My 2 cents. I'm not a doctor but worth mentioning all these things to one. I personally don't intend on ever passing a mammogram.